Study: Combined treatments are the most effective to stop smoking

Network meta-analysis of eligible comparisons for sustained abstinence (a), prolonged abstinence (b), any abstinence (c) and 7-day point prevalence abstinence (PPA) (d). Thicker edges in network figures represent comparisons with a higher number of randomized patients, while interventions with a larger number of randomized patients have larger circles. Interventions were excluded if they were disconnected from the main network. Credit: DOI: 10.1111/add.15675

This is a study, led by the University of Bristol, and published in Addiction Journal. It was funded by the National Institute for Health Research (NIHR), the research partner of the NHS, public health and social care.

The most effective tobacco cessation pharmacotherapies are combination therapies, particularly varenicline and nicotine replacement therapy (NRT) combined. Varenicline, bupropion, and NRT are recommended as first line treatments to stop smoking by the National Institute for Health and Care Excellence (NICE). 

The researchers identified 363 trials for effectiveness and 355 for safety. Most single and combination therapies were more effective than placebo at helping people to stop smoking with varenicline monotherapy and varenicline plus NRT combined being the most effective. Bupropion was also shown to be effective, but was associated with increased risks of having a serious adverse event. E-cigarettes showed promise but more research is needed to establish their safety.

It was noted that NICE will soon be releasing their new guidance for "Tobacco: preventing uptake, promoting quitting and treating dependence," which will include this study's data.

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